Individuals considering undergoing knee replacement surgery should ask their doctors to run a test to determine if they have a nickel allergy. Determining if a patient suffers from a nickel allergy will ensure the right knee implant is chosen for their surgery, and possibly save them from considerable pain and suffering down the road.

Roughly 10 percent of the population has a nickel allergy, though many don’t know it. Occasionally, a reaction to nickel-containing jewelry – usually just a mild rash on the skin that has come in contact with item – tips some people off to the allergy. But unfortunately, many knee replacement patients are unaware that they have a nickel allergy until they begin having problems from a knee implant made with the metal. If a patient with a nickel allergy is implanted with such a device, they will experience:

When a knee implant causes a nickel reaction, the device needs to be surgically removed. A spacer then will be implanted into the joint with antibiotic cement to clear up the infection. A new non-nickel knee replacement device will be implanted once the infection clears up.

Knee implant devices are made with a variety of metals. In most cases, the bearing part of the joint is made from polyethylene. The other component may consist of a chrome/cobalt alloy or stainless steel, both of which contain nickel. Non-nickel alternatives are made from either titanium, or a ceramic-coated zirconium known as “oxinium.”

Unfortunately, even though using the wrong knee implant in a person with a nickel allergy can have painful consequences, most doctors don’t order metal allergy testing prior to surgery. Patients planning knee replacement surgery should discuss this issue with their doctor, especially if they have any reason to suspect a nickel allergy.

1.) There has yet to be any useful correlation between skin patch testing results and problems with TKA implants. Just bc a patient has a positive test doesn’t mean they will have issues with standard implants. The alternative bearing surface implants are 3-4Xs more expensive and most some cases not a well studied for wear, durability and results. Bottom line many people who don’t need “special” implants may get them, possible with a shorter implant survival. Meanwhile some people with “negative” tests will still get metal-allergy type issues with implants.
2) There is some belief that skin testing itself can actually prime the bodies immune system to react to Nickel, Cobalt-Chrome, etc. having been exposed to a small sample of the metal may prime T-Cells to react more vigorously at a second exposure. So now you’ve take a “normal” patient with a negative test, put in standard implants, and then set them up to have a metal allergy type reaction.

Before you get all “your dumb doctors don’t test for this” to the public, you need to first understand that there are very good reasons why we don’t routinely skin test all patients :)